Factors Associated With Self-Risk Perception for Sexually Transmitted Diseases Among Adolescents

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Sexually transmitted disease (STD) and human immunodeficiency virus (HIV) prevention efforts focus on increasing people's awareness of their risks for these infections. Prevention programs have relied on the concept that perceptions of risk for negative consequences are critical in motivating protective health behavior.1 Perceptions of risk for STD, defined here as the likelihood that a negative outcome (e.g., disease) will occur within 6 months after having unprotected sexual intercourse, are presumed to influence subsequent sexual behaviors. We have previously shown that adolescents make decisions regarding their sexual behavior based on their perceived risk for STDs (PRSTD), and that PRSTD can predict subsequent condom use with a main sex partner.2,3 The objective of this study was to determine whether PRSTD is correlated with perceptions about partners' STD-related risk behaviors. Prevention interventions include a focus on the role of sex partners in risk for acquiring an STD, and it would be useful to know whether PRSTD is affected by perceptions about partners.Our sample consisted of adolescents who were participating in a longitudinal study at a municipal STD clinic. Eligibility criteria included: aged between 14 and 19 years old, English-speaking ability, engagement in vaginal or anal intercourse in the preceding 3 months, HIV negativity, and residence in the local metropolitan area.The participation rate at the STD clinic was 81.9%. Participation varied by age, gender, and STD history. Older adolescents, males, and those with prior STD infections were less likely to participate. Participation rates for males and females were 77.5% and 85.3%, respectively; mean age of nonparticipants was 18.0 years, whereas for participants, it was 17.6 years; 16.3% of participants had an STD history, whereas 25.9% of nonparticipants had an STD history.We limited our analysis to a total of 186 participants who reported having sex with a main partner during the last 6 months at the 6-month interview. The overall 6-month follow-up completion rate was 85.1%.At the 6-month follow-up visit, research assistants asked participants about their most recent main partners' STD/HIV-related risk behaviors. They were also asked about their own perceptions of risk for STDs with the main sex partner.We measured each individual's risk perception using a 5-item scale. Each item began with “If you have unprotected sex with your main partner in the next six months …” and completed 5 different options about the chance/likelihood/risk of contracting gonorrhea/chlamydia. We then summed the items and took the mean combined score as the measure of PRSTD; Cronbach's α on the PRSTD scale was 0.91. We defined a main sex partner as “someone you have sex with and you consider that person to be the person that you are serious about.” We assessed perceptions of risk for 2 STDs, gonorrhea and chlamydia. We described these as “diseases that cause discharge, burning, and mild pain.”Participants were also asked to identify sexual risk behaviors of their most recent main sex partner. These behaviors are outlined in Table 1.For each perceived behavior variable (6 total) and then for 2 relationship variables, we ran a series of models using PROC GLM (SAS v8.2). First, we tested the association between each perceived main partner behavior and PRSTD. We also controlled for presence of a casual partner within the last 6 months, as well as gender, and assessed interaction terms.Among adolescents in our sample (N = 186), the mean age was 17.6 years (standard deviation [SD] = 1.4), and 66.1% were female. Fifty-seven percent had at least one parent with more than a high school education.

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